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ICM - Exam 1 > 2 - Anxiety Disorders > Flashcards

2 - Anxiety Disorders Flashcards

1
Q

Anxiety disorder definition and 4 examples

A

Excessive or pathologial levels of Anxiety that interfere with function

Panic disorders, Social Phobia, GAD, Specific Phobia

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2
Q

3 Familial or Developments Factors of Anxiety Disorders

A
  • Genetic vulnerability (30-50% in monozygotic twins)
  • Developmental Features (behavioral inhibition)
  • Life Experiences/Stressors (early trauma)
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3
Q

Two brain things thought to be connected to anxiety

A

Limbic Hypersensitivity

Reduced Modulation from Cortex

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4
Q

Major site of action for antianxiety drugs

A

Limbic System

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5
Q

“Resetting the Inhibition Tone”

What is the goal and how to achieve it (three ways and Tx for each)?

A

Goal = Decrease Limbic activity

  • Strengthen Prefrontal Cortex (CBT)
  • Increase Serotonin Levels in the circuits (AntiD’s)
  • Increase GABA inhibition in the amygdala and HC (Benzo’s)
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6
Q

Psychological Treatment for Anxiety disorders

A

CBT

MABT (Mindfulness - Acceptance - Based Therapy)

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7
Q

NE effects

A

Alertness and energy

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8
Q

DA effects

A

Attention, motivation, pleasure and reward

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9
Q

Serotonin effects

A

Obsessions and compulsions

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10
Q

Drug class that works on NE, DA, 5HT

A

MAO inhibitors

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11
Q

Panic attack criteria DSM5 (3)

A

Develop sudden fear/discomfort

10min peak

at least 4 symptoms for full attack

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12
Q

DSM5 for Panic Disorder (3)

A
  1. Recurrent, unexpected panic attacks
  2. Attack followed by at least 1 month of
    1. Concern over future attacks
    2. Worry about consequences
    3. Significant behavioral change
  3. Not due to ORGANIC cause or OTHER psychiatric disorder
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13
Q

Panic disorder epidemiology, associated with…

A

affects 1-2% (attacks = 5-8%)

associated with agoraphobia, depression, etoh abuse

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14
Q

Panic disorder usually presents with…

A

a physical focus

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15
Q

Panic disorder treatments (Psych and Pharm)

A

Psych = CBT

Pharm = SSRI, Tricyclic, Benzo’s, MAOI’s

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16
Q

Which SSRI’s are effective in PD

A

All of them (sertraline, paroxetine)

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17
Q

SSRI dose for PD

A

LOW to start

Fluox and Parox = 5mg, Sert = 25mg

18
Q

Comorbidity for PD (5)

A

Depression

Agoraphobia

Other anxiety disorders

EtOH abuse

Personality disorders

19
Q

Social AD 7 criteria

A
  1. Persistent fear of one or more social situations
  2. Exposure provokes fear
  3. Fear is excessive
  4. Avoidance or endurance of feared situations
  5. 6 month persistence
  6. Significantly interferes with life
  7. NOT due to another condition
20
Q

Most common fears

A

Glossophobia

Meeting Strangers

21
Q

SAD prevalence

A
  1. 9% 1 year
  2. 3% Lifetime
22
Q

SAD male to female ratio

A

1 : 2.5

23
Q

SAD mean age of onset

A

11-15 years

24
Q

Social phobia morbidity

  • Financial
  • Education
  • Socioeconomic
  • Marital
A

22.3% were on welfare

50% No high school

70% were in lowest SE quartiles

50% were single or divorced

25
Q

Generalized Anxiety Disorder DSM5 (4 criteria)

A
  • Excessive anxiety or worry about a number of events or activities for 6 months
  • Patient finds it difficult to control the worry
  • Three of the following
    • Restlessness
    • easily fatigued
    • Difficulty concentrating
    • Irritability
    • Muscle tension
    • Sleep disturbance
  • Clinically significant impairment of function
26
Q

GAD Prevalence (Men, Women, Total)

A

Men - 3.6

Women - 6.6

Total - 5.7

27
Q

GAD age of onset (Early vs. Late)

A

Early = Before 20, Female-Dominant

Late = Adult onset, Male and female equal, Usually precipitated by Stressful event

28
Q

Useful Pharm for GAD (3)

Other Tx?

A
  • Benzo
  • Azospirones (Buspirone)
  • AD’s (SSRI)

Psychotherapies also useful

29
Q

OCD Dx (3)

A
  • Characterized by obsessions or compulsions
  • They cause significant disability or discomfort
  • One or more hour per day
30
Q

Most common OCD obsessions

A

Contamination

Fear of harm

31
Q

Characteristics of Compulsions in OCD (3)

A

Repetitive behaviors

Usually done to neutralize the anxiety induced by the obsession

Most pts acknowledge the futility

32
Q

OCD Epid.

A

2-3%

Early onset, severe in males

33
Q

OCD pathophys

A

Basal ganglia less active -> less dampening/control

34
Q

Which circuit in OCD

A

Fronto-striato-thalamo-frontal

35
Q

OCD Tx

A

SSRIs are most effective

Start at higher dose and longer duration

Always combine with CBT

36
Q

Acute stress and PTSD criteria (6)

A
  • Severe trauma
  • 1 month of Sx
  • Re-experiencing of trauma (1 or more)
  • Avoidance (1 or more)
  • Negative alterations in cognition and mood (2 or more)
  • Sx of disturbed arousal (2 or more)

Specify 1- with dissociative Sx or 2- with delayed expression

37
Q

Define trauma

A

Life threatening (or potentially) situation

Most critical elements = sense of horror and helplessness

Inherent subjective nature to the experience

38
Q

Incidence of PTSD

A

3.5% of all US adults

39
Q

___% of PTSD are considered severe

A

36.6%

40
Q

Risk factors for developing PTSD

A

Type of trauma

Gender

Age

Genetic vulnerability

41
Q

Highest populations with PTSD

A

Abused kids > Battered women > Rape victims > Military > Firefighters > Police

42
Q

PTSD Tx (Pharm and other)

A

SSRI improve half of patients, Anticonvulsants may also be useful

Combo of meds and Therapy

ICM - Exam 1 (8 decks)

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